| NPI | 1871590372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD058325L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD 0583251) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2020-08-25 |